Key result
Substandard care is identified in ~56% of maternal deaths from vascular dissection and rupture.
Why the study?
Maternal deaths attributable to vascular dissection and rupture are rare but carry high maternal and fetal morbidity and mortality, with limited data on incidence and clinical features.
Observational (n=3,108,235)
Yes
Vascular dissection and rupture in pregnancy are rare but carry high mortality, often complicated by delayed diagnosis and substandard care.
Alerts clinicians to vascular dissection risk in hypertensive pregnancies; leaves open targeted prevention and care-quality strategies.
OBJECTIVE: To determine the incidence of maternal deaths attributable to vascular dissection and rupture in the Netherlands, and to assess clinical features, risk factors and the frequency of substandard care in the cases identified. DESIGN: Confidential enquiry into the causes of maternal deaths. SETTING: Nationwide in the Netherlands. POPULATION: A total of 3,108,235 live births. METHODS: Data analysis of all cases of maternal death from vascular dissection and rupture in the period 1993-2008. A literature review was also performed. MAIN OUTCOME MEASURES: Incidence, clinical features, risk factors and frequency of substandard care. RESULTS: A total of 23 maternal deaths attributable to vascular dissection and rupture were reported. In most cases the location was aortic (n=13), followed by coronary (n=4) and splenic (n=3) arteries. Clinical features were various, but most women presented with sudden unexplainable pain. Risk factors were present in 14 cases (61%), with hypertension being most frequently reported in ten cases (43%). Substandard care was determined to have been received in 13 cases (56%), inadequate assessment of complaints and a delay in diagnosis being the most frequent problems identified. CONCLUSIONS: Vascular dissection and rupture in pregnancy, although rare, carry a high risk of maternal and fetal morbidity and mortality. Because of the rarity of this condition and its variety in presentation, diagnosis is easily missed. A high index of suspicion when a woman presents with suggestive complaints, leading to an early diagnosis, may improve the prognosis for the woman and her child.
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Chapelle et al. (2011) conducted an observational in Maternal deaths attributable to vascular dissection and rupture (n=3,108,235). Vascular dissection and rupture was evaluated on Incidence, clinical features, risk factors and frequency of substandard care. Vascular dissection and rupture accounted for 23 maternal deaths among 3,108,235 live births, with hypertension present in 43% and substandard care identified in 56% of cases.
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